Perforator Flaps In Breast Reconstruction Although the ideal material for reconstruction of the breast is skin and fat alone, most current methods of autogenous reconstruction use myocutaneous flaps. The parent blood vessels to these flaps arise on the deep surface of the muscle supplying the overlying skin and fat via musculocutaneous perforators. By carefully dissecting these perforating vessels as they course through the muscle, flaps composed of skin and fat alone may be harvested from various anatomic areas without the need for muscle sacrifice. Advantages of this method include no muscle function loss, no hernia formation, decreased postoperative pain, and a shortened hospital stay. The main drawback of the perforator flap is that meticulous microvascular technique is required and may lengthen the operative time. Donor sites that will be illustrated in this chapter are the lower abdomen, the upper buttock, the lower buttock, the back, and the lateral thigh. The choice of a donor area is based on the location of the most desirable donor tissue.
As the quality, of breast reconstruction has improved dramatically over the last 20 years, it is logical that at some point, perforator flaps, as described by, Dr. Allen, would appear as new techniques to replace standard. The TRAM flap and later the free TRAM flap both have yielded outstanding results in breast reconstruction and have served both patients and the medical community well. The one drawback, in addition to the length and magnitude of the surgery, has been the sacrifice of some of the components of the abdominal wall. Dr. Allen has taken the challenge and now has shown that the benefits of a TRAM flap and other musculocutaneous flaps can be achieved without a significant loss of muscle.
The results and technique that he has described in this chapter are excellent, and the concept of this operation is totally logical. The question remains whether it will ever achieve wide acceptance in the community of surgeons. The issues, of' course, are the difficulty of the operation, the length of time it requires, and the potential for total failure. Nevertheless, I expect that some surgeons will embrace the perforator flap for breast reconstruction and other reconstructions because the results can be excellent and the concept is exquisitely logical. The only procedure that I can imagine that will ever replace this procedure would be the transfer of homologous tissue from a tissue bank, where there is no morbidity whatsoever associated with the operation.